Online Pre-application

Filling out this pre application will enable you to have one of our volunteers contact you about hosting and discuss our program more in depth. You can also fill out this application in order to be added to the backup family list and the chaperon host list.

* Indicates required field

Family Last Name *

Family last name (example: Smith). If hyphenated, please list Father last name first (e.g., Smith-Jones)

Father's First name *

Father's full LEGAL First Name (Ex. Jonathan, not Jon) If none, please mark N/A

Father's Middle Name *

Father's LEGAL middle name. If none, leave blank.

Father's DOB *

Please list the FATHER'S date of birth (Ex. 11/30/1965)

Mother's First Name *

Mother's full LEGAL First Name (Ex. Angela, not Angie) If none, please mark N/A

Mother's Middle Name *

Mother's LEGAL middle name. If none leave blank.

Mother's DOB *

Please list the MOTHER'S date of birth

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Home Phone Number *

If none, please mark N/A

Father's Cell *

If none, please mark N/A

Mother's Cell *

If none, please mark N/A

Preferred Contact Number *

Home PhoneFather's CellMother's Cell

Father's Email Address *

Mother's Email Address *

Program of Interest *

UkraineColombiaHost a ChaperonBack Up Family Ukraine

Father's Work *

Full TimePart TimeStay at Home DadWork From Home

Mother's Work *

Full TimePart TimeStay at Home MomWork from Home

Childcare Plan: If both parents work full time, is one parent able to take off work during the hosting program? *

YesNoUnknownDoes Not Apply

Other Adults: If you have any other adults living at your home who are age 18 or older, please list them here. This would include grandparents, renters, nanny or grown children. If there are none, please enter "none". *

How many children are you hoping to host? *

1234Open

Gender of Child *

MaleFemaleEitherBoth

What is the desired gender of the child(ren) you wish to host?

Special Needs *

We may identify some children who have a physical handicap. If your family is able or interested in hosting a handicapped child, please state what handicaps you are open to considering.

Referred By? *

Who referred you to us?

Comments *

Please note any additional comments or questions below. If you are REHOSTING a child ALREADY hosted through a past program, please indicate that below as well and please CONTACT the COUNTRY DIRECTOR to REHOST. This is a short answer question. Please limit your response to 50 characters or less.

Accept Terms and Conditions

I/we certify that the information contained herein is true and correct to the best of my/our knowledge. If any of the above information is determined to be willfully stated incorrectly, I/we acknowledge that GH has the right to disqualify us from further consideration. Also, I/we understand and accept all of the hosting program information and requirements listed in this pre-application.